Community Family Medical Clinic of Bunkie LLC

Key facts

NPI: 1013546720
Entity type: Organization (NPI type 2)
Primary specialty: Rural Health Clinic/Center 261QR1300X
Legal business name: COMMUNITY FAMILY MEDICAL CLINIC OF BUNKIE LLC
Practice address: 117 W Magnolia St Ste 2
Bunkie, LA 71322-1706
Phone: (318) 346-2288
Fax: (318) 346-2299
NPI assigned: Apr 4, 2020
Organization subpart: No

Authorized official

Name: Amy Ledoux
Title: Administrator
Phone: (337) 945-1366

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Kristen D Veillon, FNP-C Family Nurse Practitioner · Bunkie, LA · NPI 1043755911

CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CORPORATE OFFICER · GENERAL PARTNERSHIP INTEREST · OPERATIONAL/MANAGERIAL CONTROL

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Angela V Huval, LCSW Clinical Social Worker · Lafayette, LA · NPI 1639489487

NPD (past)
Laurel Lachelle Sanders, LPC Professional Counselor · Alexandria, LA · NPI 1942865332

NPD (past)
Leslie Smith, FNP-C, APRN Family Nurse Practitioner · Alexandria, LA · NPI 1194341628

NPD (past) FAMILY
Regina Watson, LCSW Clinical Social Worker · Ville Platte, LA · NPI 1720231624

NPD (past)

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
19D2181685	Community Family Medical Clinic of Bunkie, LLC 117 W Magnolia, Suite 2, Bunkie, LA 71322	Certificate of waiver	Apr 8, 2028

Medicare participation

Medicare fee-for-service enrollment: Enrolled in LA

Rural health clinic certification: CCN 198901

Legal name: COMMUNITY FAMILY MEDICAL CLINIC OF BUNKIE LLC
Doing business as: COMMUNITY FAMILY MEDICAL CLINIC
Certification status: Active
Provider type (POS): Rural health clinic
Participating since: Feb 23, 2022
Last certification: Feb 23, 2025
Ownership / control type: 1C
Organization structure: LLC · Proprietary
Incorporated: Mar 18, 2020 in LA
Enrollment address: 117 W Magnolia St
Ste 2
Bunkie, LA 71322-1706

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Name	Role	Since	Share
Kristen D Veillon Individual	5% Or Greater Direct Ownership Interest Owner	Mar 18, 2020	50%
	General Partnership Interest Co-Owner	Mar 18, 2020	50%
	Corporate Officer	Mar 18, 2020
	Operational/Managerial Control Owner	Mar 18, 2020	50%
Nicholas Veillon Individual	5% Or Greater Direct Ownership Interest Co-Owner	Mar 18, 2020	50%
	General Partnership Interest Co-Owner	Mar 18, 2020	50%
	Corporate Officer Co-Owner	Mar 18, 2020	50%

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20210915000289	LA	Part a Provider - Rural Health Clinic	2769813492	Practice locations: Bunkie, LA

National Provider Directory

Locations

117 W Magnolia St
Bunkie, LA 71322
Phone (318) 346-2288

117 W Magnolia St
Ste 2
Bunkie, LA 71322
Phone (318) 346-2288

504 Jack Miller Rd
Ste 9
Ville Platte, LA 70586
Phone (337) 363-7228

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Rural Health Clinic/Center	261QR1300X			Yes
Family Nurse Practitioner Group: 193400000X SINGLE SPECIALTY GROUP	363LF0000X

Addresses

Primary practice location

117 W Magnolia St Ste 2
Bunkie, LA 71322-1706

Mailing address

PO Box 67
Ville Platte, LA 70586-0067
Phone (337) 945-1366

Other providers in Bunkie, LA

All providers in Bunkie, LA · Rural Health Clinic/Center in Louisiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.